title: Intrapulmonary rFVIIa for life threatening pulmonary hemorrhage in a case of relapsing acute lymphoblastic leukemia and platelet refractoriness.
abstract: Platelet refractoriness may lead to life-threatening gastro-intestinal, intracranial or pulmonary hemorrhage that is difficult to control despite massive platelet and red cell transfusion, antifibrinolytic agents, high dose corticosteroids, immunoglobulin and intravenous (I.V.) recombinant activated factor VII (rFVIIa). In cases with pulmonary hemorrhage, intrapulmonary administration of rFVIIa may be more effective in non-responsive cases. We report a 51-year-old man with relapsing acute lymphoblastic leukemia (ALL) and platelet refractoriness, who suffered a life-threatening pulmonary hemorrhage that was refractory to massive platelet transfusion, tranexamic acid, high dose corticosteroids, immunoglobulin and intravenous rFVIIa, but responded immediately to a single intrapulmonary dose of rFVIIa that was inhaled with a jet nebulizer assistance through the endotracheal tube.
authors.affiliation: Center of Excellence in Thrombosis and Hemostasis, College of Medicine and King Khalid University Hospital, King Saud University , Riyadh , Saudi Arabia .
authors.forename: Abdulkareem
authors.initials: A
authors.lastname: Almomen
authors.forename: Aamer
authors.initials: A
authors.lastname: Aleem
authors.forename: Mashael
authors.initials: M
authors.lastname: Alshaik
authors.forename: Rana
authors.initials: R
authors.lastname: Hasanato
mesh_terms: D000280:Administration, Inhalation; D001792:Blood Platelets; D015942:Factor VIIa / Q000008:administration & dosage*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: Novoseven; platelet refractoriness; pulmonary hemorrhage; recombinant factor VIIa